978-1572305441

Trevor 139 autistic

Trevor 139 autistic behaviors—the echolalia, the motor mannerisms, and the behavior problems—often diminish on their own. Reducing autistic behaviors should be a goal only if they interfere with daily functioning or with delivering therapy. In addition, punishments are no longer used. Not only are punishments unethical, but if one of the goals of therapy is to encourage the child to interact with others, particularly adults, then delivering punishments will only teach children with ASD to be wary of adults. Nor is it realistic to expect a cure, in spite of the claims of some testimonials. Sometimes, however, the degree of improvement can be quite remarkable and heartening. This realization has been accompanied by increasing evidence that early intervention can make a significant difference to the growth and development of children with ASD. Children who are initially nonverbal can begin to speak, children who do not follow simple directions can now do so, children who are socially isolated can now start to play with other children. Problems remain in the core difficulties of theory of mind, of weak central coherence and executive function, but they seem less severe. The impact of treatment is such that children with autism look more and more like children with AS or atypical autism, and these latter two groups look more and more like children with learning disabilities or with attention deficit. They may not look or behave normally all the time, but they are on a more developmentally appropriate pathway. The main approach to early intervention based on the available scientific evidence is “applied behavioral analysis” (ABA), combined with a developmental approach to autism. This generic method focuses on understanding the function that behavior plays in a particular situation and attempts to teach more developmentally appropriate behaviors with a well-defined set of learning methodologies. By integrating ABA with a developmental approach these skills are taught in a sequence that attempts to follow typical developmental processes. These integrated methods also take into account how children with ASD learn—how they process information, especially information with a strong social and communication component, at different stages of their development. This can be much more difficult to accomplish than teaching compliance or the utterance of simple words to indicate preference, and it’s what makes the application of ABA to children with ASD more complicated than to children with more general developmental delays. There are several forms of early intervention, but the two most well known are “discrete trial training” and naturalistic teaching or “social–

140 A MIND APART communication therapy.” These are not mutually exclusive and can be seen as lying on a continuum from highly structured behavioral ABA approaches such as discrete trial training to more naturalistic “developmental” ones. Both ends of the continuum have been evaluated systematically and scientifically in a number of studies and have been found to be effective, though many unanswered questions remain. There are several different variations to each, but the two main therapies have much in common. They are both intensive, start early, involve twenty to forty hours of treatment a week, though admittedly administering more than twenty-five hours per week is very difficult in most circumstances. Both also employ behavioral strategies to facilitate learning. They are also intrusive to the extent that the child is not allowed to disengage from the world entirely and to retreat into repetitive and solitary play. Staff who deliver the treatment are highly trained, and parents are actively involved in setting goals and in administering the treatment program, and are also taught a number of techniques to foster social interaction, language, and play. Both include systematic attempts to generalize treatment gains from one setting to another. For example, if a child with autism learns to play with a therapist, there is no guarantee that he will be able to play with parents or siblings. These skills need to be generalized across people but also across settings (like from school to home). Both approaches emphasize understanding what function a certain behavior serves, how new skills can be established step by step, how to use rewards to reinforce more developmentally appropriate behavior, how to use structure and a visual schedule to make transitions easier, and how maladaptive behaviors can be eliminated. But there are also some important differences. Discrete trial training concentrates on promoting compliance and simple cognitive, language, and attentional skills through a strict application of learning principles. Therapeutic sessions are highly structured and directive, are largely done one on one with an adult, and have a strong training component. An example of a session using discrete trial training might involve a child sitting behind a table with the therapist sitting opposite to remove any distractions. The therapist puts two pictures down on the table and asks the child to indicate whether these are the “same” or “different.” If the child is correct, he is rewarded. If not, the trial is given again. This procedure is done over and over again till the child can indicate the correct answer several times in a row. Once that skill is mastered, the child and therapist go on to the next skill in the curriculum. That next skill tends to be a bit more developmentally advanced, but